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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700082
Report Date: 05/17/2019
Date Signed: 05/17/2019 03:31:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CARLSBAD EDUCATIONAL FOUNDATION-CALAVERA HILLSFACILITY NUMBER:
376700082
ADMINISTRATOR:SAMARA WHITEFACILITY TYPE:
840
ADDRESS:4101-4104 TAMARACK AVE.TELEPHONE:
(760) 331-6387
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:110CENSUS: 26DATE:
05/17/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Site Supervisor Samara WhiteTIME COMPLETED:
03:40 PM
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Licensing Program Analyst, Joelle Redding, made an unannounced visit to follow up on a self reported incident that occurred on 5/2/19 wherein a 7 year old child (Child #1) slipped off the monkey bars, sustaining a sprained arm.

LPA spoke with Staff #1 who was standing beside Child #1 when the incident occurred. She stated that Child #1 was on the monkey bars beside her, lost her grip and fell, rolling on to her left arm. Staff #1 stated that it happened so fast that, even though she was right beside her, she wasn't quick enough to intervene. LPA spoke with Child #1. Her statement corroborated that of Staff #1. Child #1 stated that tried to use her left arm to brace herself to protect the finger on her right had that she had sprained before. Staff #1 stated that she contacted Site Supervisor Samara White by walkie talkie. Ms. White brought an ice pack and contacted Child #1's parent for pick up. The child had a doctor's appointment already scheduled for that day and she was diagnosed with a slight sprain, requiring a splint and harness for a a couple of days. She returned to care the following day

LPA inspected the area of the playground and the play structure where the child was injured. The play structure and monkey bars are age appropriate for a 7 year old. The cushioning is standard for elementary school playgrounds. The program has since made the monkey bar portion of the play structure off limits.

The facility was in ratio with 35 children and three staff outside, supervision was present with Staff #1 standing beside Child #1, staff responded appropriately and the facility reported timely. A photo of the monkey bar area was included.

No deficiencies are cited.
Notice of Site Visit was posted and will remain posted for 30 days.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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